Pharmacy Revenue Cycle Claims Specialist

Boston Medical Center; United States; Remoto; USD 56.000 - 79.000; Tempo integral

Resumo da vaga

Boston Medical Center is seeking a Claims Analyst for Pharmacy Revenue Cycle to enhance reimbursement accuracy and cash flow. The role requires strong knowledge of Medicare, coding guidelines, and payer contracts, with emphasis on resolving denials and optimizing billing processes.

You will collaborate across departments, monitor claims queues in EPIC, and communicate findings through meetings and reports. A Bachelor's degree or equivalent experience and 1–3 years in healthcare revenue cycle are

Qualificações

• Research, resolve, and prepare claims that have not passed payer edits daily.
• Serve as subject matter expert for provider relationships, service issues, reimbursement and claims.
• Read, analyze and interpret prescription drug orders.
• Monitor rejections on electronic and paper claims to improve system edits.
• Knowledge of Medicare, third-party codes and billing procedures.
• Communicate issues via meetings, emails, and presentations.
• Regulatory billing guidelines and industry standards knowledge.
• Collaborate with team to improve denials and avoidable write-offs.
• Prepare reports for review and analysis.
• Follow-up on 45-day balances to maximize client satisfaction and provider profitability.
• Adhere to RESPECT behavioral standards.

Conhecimentos

Billing knowledge

Analytical ability

Claims management

NCCI Edits

Medicare guidelines

CMS1500 submission

Formação

Bachelor’s degree or equivalent

Ferramentas

EPIC system

Descrição da vaga

Boston Medical Center is seeking a Claims Analyst for Pharmacy Revenue Cycle to enhance reimbursement accuracy and cash flow. The role requires strong knowledge of Medicare, coding guidelines, and payer contracts, with emphasis on resolving denials and optimizing billing processes.

You will collaborate across departments, monitor claims queues in EPIC, and communicate findings through meetings and reports. A Bachelor's degree or equivalent experience and 1–3 years in healthcare revenue cycle are